Cribriform

Hi all,

on another thread, this perennial question came up yet again, so I thought I might clarify things AS I SEE IT.  (disclaimer…I’m NOT a consultant- just offering some food for thought).

So, cribriform has a bad reputation. So it should… HOWEVER, it is merely an observation that helps people decide whether to stay on active surveillance (AS) or go for focal treatment or proceed to radical treatment. Many consultants think it should not be included on histology reports, as it is not the only aggressive feature to be found. If you Google it, it is initially very scary until you dig deeper.  But I have found that it is reported to help consultants decide on the best way ahead for the patient.  If you had, say Gleason 3-4 with no cribriform, then you may wish to stay on AS for a while. But if the 4 includes cribriform, then it’s already becoming aggressive and needs to be treated. It goes without saying that a Gleason 5 within the two digits indicates aggressive carcinoma that needs to be treated. 

I have 4-3 with cribriform.  I chose brachytherapy boost (see my bio for details- I originally wanted RP, but the side effects put me off, and also with T3a carcinoma, the surgeon warned me there was a 30% chance that he would not get it all out).  If surgery doesn’t remove it all, then salvage RT would be required with two sets of side effects (and the months of no HT going down the surgery route would have given micro metastasis cells more time to walk about). This is my reasoning for choosing my pathway (remember, I am NOT a consultant, but I’ve done my own research):

If you have cribriform (latin word - crib - a basket weave type of open structure between the cells of the carcinoma) in the Gleason 4 part of your histology, this means that it is likely to be heading for Gleason 5 (a very open, stratified structure between the cells of the carcinoma).  Think of Grade 4 with cribriform as being “Grade 4+” if you like.  All this fancy talk means is that little microscopic bits of the carcinoma can break away from the original carcinoma in the prostate glans and go “walk about “ as Millibob would say.

This is the reason I went down the HT/RT route. The HT was required quickly (as opposed to waiting for RP surgery, where they usually don’t give HT because they want to check the pathology of the removed gland and surrounding area for clear surgical margins). HT would shrink the carcinoma and perhaps cloud the cell diagnosis. HT should suppress and weaken (possibly starve & kill) any “walk about “ stray cells whilst waiting for your RT to happen when the carcinoma is at its weakest.

The reason I wanted the brachytherapy boost was because I wanted to increase the RT dose (internally via the LDR seeds) to the “mother ship” to make sure no tiny bits were left to break away in future.  so far, so good, 6 days after my operation, bladder and bowel functioning normally. No change in size to any organs either, if you follow my drift. 

Delivery some RT internally means that they can also reduce the dose to the surrounding pelvis when they do the external beam RT in January next year.  Down from 73Gy to 46 Gy.  This decreases the damage to surrounding tissues as all beam RT has to pass through to get to the prostate (albeit from different angles).  My aim was to reduce side effects.  

I do hope this helps you formulate questions for your own consultants.  Remember, please, that I AM NOT A CONSULTANT.